Wednesday, August 10, 2005

EDITORIAL >> Insuring uninsured

The elderly and then children were the people who could not afford insurance and were “underserved” by the health-care system. Medicare under Lyndon B. Johnson and Medicaid expansion under Bill Clinton largely but not altogether solved those problems. Now a different group, reasonably young working adults, is the population in distress.

In few places are they in greater distress than Arkansas. The Arkansas Center for Health Improvement gave lawmakers the unnerving figures this week. Thirty percent of Arkansans between 19 and 44 are not insured, and the percentage is up 7 percent from only four years ago. The share of people from 44 to 64 and children who are uninsured is somewhat smaller but still rising.

But surely these are just deadbeats or else vibrant and prosperous young people who just do not need insurance or think they do not need it? No, the Center for Health Improvement calculated, they are working people on the low end of the pay scale, and most of them work for small businesses, those with fewer than 50 workers.

Is this a crisis, and should the rest of us take any personal interest in it except for an earnest mention in our prayers? You decide.

At some point, when their condition gets very serious, most of the uninsured wind up getting some medical attention — usually in the emergency rooms — although they cannot pay for the care and it is written off. Private hospitals and clinics shift the cost to other patients and their health insurance. Every indigent’s care adds to your premiums.The medical director of the University of Arkansas Medical Center said his hospital spent almost $40 million a year serving the uninsured, and that the figure is rising. Those are dollars you pay directly. The legislature appropriates your tax dollars every year to operate the hospital.

That is not all that you pay for the uninsured. Your share, from the sales, income, cigarette and alcohol taxes you pay, comes to tens of millions poured into Medicaid each year for the state’s part of medical care for children under Gov. Huckabee’s ArKids First program and medical services for qualifying adults. You might as well count the three-fourths share that Washington covers each year. Those are your taxes, too. Health insurance is considered a national problem, one too daunting for poor states to tackle. But in the absence of federal action, more and more states are innovating to get more of their residents insured. State governments have always been laboratories where formulas for national problems are developed.

Gov. Huckabee and his state health director vowed several years ago to find an Arkansas solution, but the governor is yet to deliver. It is no easy task. But his new state health officer came up with a plan with great promise last year: Have businesses with low-wage workers pay premiums into Medicaid to cover the state’s 25 percent share for the companies’ poor workers. The federal government would pay the usual match. Huckabee submitted the plan to the Bush administration, which has not signed a waiver to implement the plan and, we suspect, never will.

But here’s a promising development worth our legislature’s attention. An Idaho Republican introduced legislation last week that would require Idaho businesses that do not currently provide insurance for their low-income workers to either insure them or reimburse the state government for the cost of providing medical care for their employees and families under Medicaid. The Republican was upset when he saw figures about the state’s cost providing medical care for the employees of Wal-Mart and other big discount companies.

The Arkansas Department of Human Services this spring said that the state Medicaid program paid the hospital and doctor costs for about 10,000 employees of the state’s nine largest employers. Altogether, Medicaid annually covers medical expenses for about 350,000 workers and families in Arkansas who are not insured through the workplace and cannot themselves afford to buy more expensive individual coverage.

Perhaps some bold Republican will propose something similar for Arkansas. Maybe not. But members of the Legislative Council Monday seemed to want to study it, again. Gov. Huckabee ought to put his new state health officer, Dr. Joe Thompson, on the task. That would give us greater hope than another legislative study.